How will you educate future doctors?

“Education is not preparation for life; education is life itself.”
– John Dewey

I stood there in awe as I watched the trauma team leap into action as the patient was rolled into the trauma bay. “Crush injury,” they said. Vitals were terribly unstable, and the patient was decompensating quickly. The corner of the room shielded me somewhat from the organized chaos that ensued and also gave me a great vantage point from which to observe all. I saw the paramedics calling out vitals and current treatments, the nurses starting peripheral lines, the tech prepping for a stat chest/pelvic X-ray, the ED resident placing an ET tube, and the trauma surgical resident swabbing the groin for a central line placement. Then I looked up and saw two obviously more senior physicians standing quietly near the entry with their arms crossed. You could see the mental calculations being performed and silent judgments being made.

Then it happened, the surgical resident withdrew the needle from the catheter and bright red blood began to spurt out in that all too characteristic arterial fashion. He had missed the vein and struck the artery — a surgical sin, one might say. Suddenly, the quiet observer near the door became not so quiet. The yelling ensued and the subtle belittling continued throughout the remainder of the trauma. On a later trauma, I observed this same senior physician being belittled by their superior in front of everyone, and it all made sense.

This sense of passing it down, carrying on the tradition, teaching them that being a physician/surgeon is stressful, etc. has been hashed out endlessly for years and has been written about countless times. Change has started to take place at most institutions and as the older generation of physicians moves on, the new generation of doctors begin to find their own ways to teach, for better or worse. At its best, education is empowering, inspiring and enlightening; at its worse it is defeating, demoralizing, and ineffective. So, the question becomes: How will you educate?

Throughout my time in the military, I had the pleasure of serving under some of the finest leaders I have ever met and also under some of the most loathsome individuals, who called themselves leaders. I learned very quickly that one of the biggest differences between good leaders and bad leaders was in how they would speak to you. Poor leaders would scream at you for no reason, belittle you for making mistakes, and then walk off huffing and puffing. Great leaders, on the other hand, would teach you by example, observe your attempts and make corrections where necessary, calmly and with understanding. They would also praise in public, punish in private, and get to know you personally.

The pervasive thought in the military is that yelling and physical exertion, stress an individual, similarly enough to a combat situation, thereby preparing them for such. While I do not disagree with this entirely, it needs further refinement. Causing high amounts of stress to simulate combat during pre-deployment preparations is needed to prepare troops for war. However, causing excessive stress while teaching lifesaving skills is ineffective, inefficient and potentially harmful. The other place where causing superfluous stress is completely uncalled for is during battle itself, much like an attending yelling at a resident in the middle of a trauma resuscitation. The pressure is already so high that any extra only serves to hinder learning and make for unfavorable patient outcomes.

As a medical student, the best education I have received came not from the endless lectures, the countless pages read or the innumerable exams we take, but rather directly from physicians who took a few moments to teach. When I first began, I was slightly irritated that I was supposed to just follow around a resident/attending while they saw patients. That was not the reason I went to medical school; I went to medical school to see my own patients and save lives. I wanted hands-on experience and I wanted it now. Then a physician gently explained to me that I wasn’t there to just follow them around, I was there to observe how they interacted with the patients and of the importance that building rapport has on patient outcomes.

During a subsequent experience, after presenting a patient to the attending, he asked for more information, for treatment plans, the whens, and the whys. When I quickly ran out of answers and apologized, he first told me not to be sorry and that he was going to ask questions until I couldn’t answer any longer, because then he knew what to teach me. He then sat for maybe five minutes explaining why drug X would be better for the situation and the physiology that drove that decision. I have never forgotten that experience, nor have I forgotten the information taught that day. Equally as memorable, was the resident who snatched the laryngoscope out of my hand as I stood at the head of the bed prepared to intubate, as he grumbled, “I don’t have time for this today.” The only thing I learned that day was that resident was the one to avoid, the one to not offer help to, and the one for whom I would never stay late.

Fully understanding that this career has little wiggle room for mistakes, little extra time for anything and countless frustrations, we must constantly remind ourselves that each of us is responsible for the molding of the next generation of physicians. And, how we mold them will determine the quality of physicians they become. The five minutes you spend calmly educating a medical student today, may save countless lives in the future, and one of those lives may be your own.